Comparison of ICU and non-ICU patients infected with the 2009 H1N1 influenza virus in a Florida Children’s Hospital between April and December 2009

Abstract

Abstract. We conducted a retrospective comparative review of children < 21 years of age infected with the 2009 H1N1 influenza virus hospitalized between April and December 2009 in northeast Florida, United States. Patients admitted to the Pediatric Intensive Care Unit (PICU) and general medical ward were compared based on patient demographics, chronic medical conditions, complications, co-infections, length of stay and outcome. Of the 119 hospitalized children, 25 (21%) were admitted to the PICU and 94 (79%) were admitted to the general medical ward. Overall, there were 63 (53%) male and 54 (45%) African-American. Mean age was 6.4 years with 52 (44%) patients < 5 years of age. Fever was seen in 114 (96%) patients and 60 (50%) patients had respiratory distress of varying severity. More than 70% of patients had at least one chronic medical condition, with the three most common being pulmonary, immunosuppression and neurodevelopmental conditions. The incidence of microbiologically-proven co-infections and mortality rate were 6.7% and 0.8%, respectively. Patients stayed at the hospital for an average of 4.3 days. Our analysis demonstrated that patients in the PICU had a statistically significant higher rate of chronic medical conditions, complications and longer lengths of stay compared to patients admitted to the general medical ward.

Key words: H1N1, influenza, pandemic flu

Keywords

• H1N1, influenza, pandemic flu

Kaynakça

1. CDC. Swine influenza A (H1N1) infection in two children–Southern California, March-April 2009. MMWR 2009; 58: 470-472.
2. Statement to the press by WHO-Director General Dr. Margaret Chan. World now at the start of 2009 influenza pandemic. Available at: http: // www. Who. Int / mediacentre / news / statements / 2009 / h1n1_pandemic_phase6_20090611 / en / index. html. Accessed on May 25, 2010.
3. Garten RJ, Davis CT, Russell CA, et al. Antigenic and genetic characteristics of the early isolates of swine-origin 2009 A (H1N1) influenza viruses circulating in humans. Science 2009; 325: 197-201.
4. Smith GJ, Vijaykrishna D, Bahl J, et al. Origins and evolutionary genomics of the 2009 swine-origin H1N1 influenza A epidemic. Nature 2009; 459: 1122-1125.
5. CDC. Updated CDC estimates of 2009 H1N1 cases, hospitalizations and deaths in the United States, April 2009-April 10, 2010. Available at: http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.h tm. Accessed on May 24, 2010.
6. Jain S, Kamimoto L, Bramley AM, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med 2009; 361: 1935-1944.
7. Louie JK, Guevara H, Boston E, et al. Rapid influenza antigen test for diagnosis of pandemic (H1N1) 2009. Emerg Infect Dis 2010: 16; 824-826.
8. Drexler JF, Helmer A, Kirberg H, et al. Poor clinical sensitivity of rapid antigen test for influenza A pandemic (H1N1) 2009 virus. Emerg Infect Dis 2009; 15: 1662-1664.

9. Libster R, Bugna J, Coviello S, et al. Pediatric hospitalizations associated with 2009 pandemic influenza A(H1N1) in Argentina. N Engl J Med 2009; 362: 45-55.
10. Kumar S, Havens PL, Chusid MJ, et al. Clinical and epidemiological characteristics of children hospitalized with 2009 pandemic H1N1 Influenza A infection. Pediatr Infect Dis J 2010; 29: 591-594.
11. Lockman JL, Fischer WA, Perl TM, Valsamakis A, Nichols DG. The critically ill child with novel H1N1 influenza A: a case series. Pediatr Crit Care Med 2010; 11: 173-178.
12. Bhat N, Wright JG, Broder KR, et al. Influenza- associated deaths among children in the United States, 2003-2004. N Engl J Med 2005; 353: 2559- 2567.
13. Coffin SE, Zaoutis TE, Rosenquist AB, et al. Incidence, complications, and risk factors for prolonged stay in children hospitalized with community-acquired influenza. Pediatrics 2007; 119: 740-748.
14. CDC. Intensive-care patients with severe novel influenza A (H1N1) virus infection–Michigan, June 2009. MMWR 2009.
15. Australia and New Zealand Extracoporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators. Extracorporeal membrane oxygenation for 2009 Influenza A (H1N1) Acute Respiratory Distress Syndrome. JAMA 2009; 302: 1888-1895.
16. Treanor JJ, Hayden FG, Vrooman PS, et al. Efficacy and Safety of the Oral Neuraminidase Inhibitor Oseltamivir in Treating Acute Influenza. JAMA 2000; 283: 1016-1024.
17. Updated interim recommendations for the use of antiviral medications in the treatment and prevention of influenza for the 2009-2010 season. Available at: http://www.cdc.gov/h1n1flu/recommendations.htm. Accessed on May 24, 2010.
18. Koy T, Starke J. In-depth analysis of patients with confirmed novel H1N1 influenza admitted to Pediatric Intensive Care Unit [Abstract 218]. In: Fifth Decennial International Conference on Healthcare-Associated Infections 2010, Atlanta, GA, March 18-22, 2010.
19. CDC. Surveillance for pediatric deaths associated with 2009 pandemic influenza A (H1N1) virus infection–United States, April–August 2009. MMWR 2009; 58: 941-947.